1
|
Forseth B, Appelhans BM, Davis AM. Considerations for Interpreting Childhood Obesity Treatment Trials from the COVID-19 Pandemic Era. Child Obes 2024. [PMID: 38683578 DOI: 10.1089/chi.2024.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Bethany Forseth
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA
| | - Bradley M Appelhans
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
2
|
Kempaiah P, Libertin CR, Chitale RA, Naeyma I, Pleqi V, Sheele JM, Iandiorio MJ, Hoogesteijn AL, Caulfield TR, Rivas AL. Decoding Immuno-Competence: A Novel Analysis of Complete Blood Cell Count Data in COVID-19 Outcomes. Biomedicines 2024; 12:871. [PMID: 38672225 PMCID: PMC11048687 DOI: 10.3390/biomedicines12040871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND While 'immuno-competence' is a well-known term, it lacks an operational definition. To address this omission, this study explored whether the temporal and structured data of the complete blood cell count (CBC) can rapidly estimate immuno-competence. To this end, one or more ratios that included data on all monocytes, lymphocytes and neutrophils were investigated. MATERIALS AND METHODS Longitudinal CBC data collected from 101 COVID-19 patients (291 observations) were analyzed. Dynamics were estimated with several approaches, which included non-structured (the classic CBC format) and structured data. Structured data were assessed as complex ratios that capture multicellular interactions among leukocytes. In comparing survivors with non-survivors, the hypothesis that immuno-competence may exhibit feedback-like (oscillatory or cyclic) responses was tested. RESULTS While non-structured data did not distinguish survivors from non-survivors, structured data revealed immunological and statistical differences between outcomes: while survivors exhibited oscillatory data patterns, non-survivors did not. In survivors, many variables (including IL-6, hemoglobin and several complex indicators) showed values above or below the levels observed on day 1 of the hospitalization period, displaying L-shaped data distributions (positive kurtosis). In contrast, non-survivors did not exhibit kurtosis. Three immunologically defined data subsets included only survivors. Because information was based on visual patterns generated in real time, this method can, potentially, provide information rapidly. DISCUSSION The hypothesis that immuno-competence expresses feedback-like loops when immunological data are structured was not rejected. This function seemed to be impaired in immuno-suppressed individuals. While this method rapidly informs, it is only a guide that, to be confirmed, requires additional tests. Despite this limitation, the fact that three protective (survival-associated) immunological data subsets were observed since day 1 supports many clinical decisions, including the early and personalized prognosis and identification of targets that immunomodulatory therapies could pursue. Because it extracts more information from the same data, structured data may replace the century-old format of the CBC.
Collapse
Affiliation(s)
- Prakasha Kempaiah
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA; (P.K.); (V.P.)
| | | | - Rohit A. Chitale
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Islam Naeyma
- Department of Neuroscience, Division of QHS Computational Biology, Mayo Clinic, Jacksonville, FL 32224, USA; (I.N.); (T.R.C.)
| | - Vasili Pleqi
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA; (P.K.); (V.P.)
| | | | - Michelle J. Iandiorio
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | | | - Thomas R. Caulfield
- Department of Neuroscience, Division of QHS Computational Biology, Mayo Clinic, Jacksonville, FL 32224, USA; (I.N.); (T.R.C.)
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ariel L. Rivas
- Center for Global Health, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| |
Collapse
|
3
|
Fanning JT, Barnstaple R, Babcock P, Black A, Collier N, Linville MC, McGee C, Morgan AR, Rice P, Thomas JT, Thumuluri D, Vogeley A, Laurita-Spanglet J, Hugenschmidt CE, Soriano CT. Virtual delivery of improvisational movement and social engagement interventions in the IMOVE trial during the COVID-19 pandemic. Contemp Clin Trials Commun 2023; 33:101102. [PMID: 36969988 PMCID: PMC10023198 DOI: 10.1016/j.conctc.2023.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Background IMOVE evaluated the contributions of movement and social engagement to quality of life, brain network connectivity, and motor and social-emotional functioning in people with early-stage Alzheimer's disease participating with a caregiver. In response to COVID-19 restrictions, a pilot study was conducted to assess integrity of key elements of the intervention and feasibility of virtual intervention delivery. Methods Participants in the parent study were randomized to one of 4 study conditions (Movement Group [MG], Movement Alone [MA], Social Group [SG], or Usual Care [UC; control]). To test virtual adaptations of each condition, groups of three participant-caregiver dyads (6 individuals) who had completed the parent trial participated in virtual adaptation classes. We adopted an engineering-inspired, rapid refinement model to optimize virtual interventions on the dimensions of social connectedness, fun, and physical exertion. After completing one iteration, participants gave feedback and adjustments were made to the intervention. This process was repeated until no further adjustments were needed. Results The MA arm easily transitioned to virtual format. The virtual MG intervention required the most iterations, with participants reporting needs for additional technology support, higher level of physical exertion, and stronger social connection. The virtual SG intervention reported good social connection, but needed additional technology instruction and measures to promote equal participation. Conclusions Our pilot study results underscore the feasibility of delivering remote social and/or dance interventions for older adults and provide a useful road map for other research teams interested in increasing their reach by adapting in-person group behavioral interventions for remote delivery.
Collapse
Affiliation(s)
- Jason T. Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Rebecca Barnstaple
- Department of Dance, York University, 301 Accolade East Building, 85 York Boulevard, Toronto, ON, Canada
| | - Phyllis Babcock
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amanda Black
- Department of Theatre and Dance, Wake Forest University, Winston-Salem, NC, USA
| | - Natasha Collier
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - M. Constance Linville
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina McGee
- Department of Theatre and Dance, Wake Forest University, Winston-Salem, NC, USA
| | - Ashley R. Morgan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paige Rice
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jantira T. Thomas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepthi Thumuluri
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Abby Vogeley
- Department of Theatre and Dance, Wake Forest University, Winston-Salem, NC, USA
| | | | - Christina E. Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | |
Collapse
|
4
|
Salovaara PK, Li C, Nicholson A, Lipsitz SR, Natarajan S. Navigating COVID-19 and related challenges to completing clinical trials: Lessons from the PATRIOT and STEP-UP randomized prevention trials. Clin Trials 2023; 20:153-165. [PMID: 36562090 PMCID: PMC9790858 DOI: 10.1177/17407745221140041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS High follow-up is critical in randomized clinical trials. We developed novel approaches to modify in-person visits and complete follow-up during COVID-19. Since these strategies are broadly applicable to circumstances wherein follow-up is difficult, they may help in contingency planning. The objective of this article is to develop and evaluate new approaches to replace detailed, in-person study visits for two trials focused on preventing diabetic foot complications. METHODS A quasi-experimental pre-post design compared approaches for follow-up during COVID-19 to approaches pre-COVID-19. Study subjects were outpatients at two Veterans Affairs Medical Centers. Following a research "hold," research resumed in February 2021 for Self-monitoring, Thermometry and Educating Patients for Ulcer Prevention (STEP UP) (n = 241), which focused on preventing recurrent foot ulcers, and in April 2021 for Preventing Amputation by Tailored Risk-based Intervention to Optimize Therapy (PATRIOT) (n = 406), which focused on preventing pre-ulcerative and ulcerative lesions. To complete data collection, we shortened visits, focused on primary and secondary outcomes, and conducted virtual visits when appropriate. For STEP UP, we created a 20-min assessment process that could be administered by phone. Since PATRIOT required plantar photographs to assess foot lesions, we conducted short face-to-face visits. We explored differences and assessed proportion completing visit, visit completion/100 person-months and compared COVID-19 to pre- COVID-19 using unadjusted risk ratios, incidence rate ratios, all with associated 95% confidence intervals (CIs). Finally, we report time-to-visit curves. RESULTS In both studies, participants whose follow-up concluded pre- COVID-19 seemed older than those whose follow-up concluded during COVID-19 (PATRIOT: 68.0 (67.2, 68.9) versus 65.2 years (61.9, 68.5); STEP UP: 67.5 (66.2, 68.9) versus 65.3 (63.3, 67.3)). For STEP UP, we completed 91 visits pre- COVID-19 (37.8% (31.6%, 44.2%)) and 63 visits during COVID-19 (78.8% (68.2%, 87.1%)). This was over 1309 person-months pre-COVID-19, and over 208.8 person-months during COVID-19; the visit completion rate/100 person-months were: pre-COVID-19 7.0 (5.6, 8.5), COVID-19 30.2 (23.2, 38.6); risk ratio: 2.1 (1.7, 2.5); and incidence rate ratio 4.3 (3.1, 5.9). Similarly, for PATRIOT, we completed 316 visits pre-COVID-19 (77.8% (73.5%, 81.8%)) and 27 assessments during COVID-19 (84.4% (67.2%, 94.7%)). This was over 1192.7 person-months pre-COVID-19 and 39.3 person-months during COVID-19. The visit completion rate/100 person-months in PATRIOT were: pre-COVID-19 2.7 (2.4, 3.0), COVID-19 6.9 (4.5, 10); risk ratio 1.1 (0.9, 1.3); incidence rate ratio 2.6 (1.8, 3.8). For both studies, the follow-up curves began separating at < 2 months. CONCLUSIONS We achieved higher completion rates during COVID-19 compared to pre-COVID-19 by modifying visits and focusing on primary and secondary outcomes. These strategies prevent excessive missing data, support more valid conclusions, and improve efficiency. They may provide important alternative strategies to achieving higher follow-up in randomized clinical trials.
Collapse
Affiliation(s)
- Priscilla K Salovaara
- Columbia University, New York, NY, USA.,VA New York Harbor Healthcare System, New York, NY, USA
| | - Christine Li
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University, New York, NY, USA
| | - Andrew Nicholson
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - Stuart R Lipsitz
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
5
|
Aarnio-Peterson CM, Mara CA, Modi AC, Matthews A, Le Grange D, Shaffer A. Augmenting family based treatment with emotion coaching for adolescents with anorexia nervosa and atypical anorexia nervosa: Trial design and methodological report. Contemp Clin Trials Commun 2023; 33:101118. [PMID: 37008797 PMCID: PMC10064114 DOI: 10.1016/j.conctc.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
This article characterizes the design, recruitment, methodology, participant characteristics, and preliminary feasibility and acceptability of the Families Ending Eating Disorders (FEED) open pilot study. FEED augments family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) with an emotion coaching (EC) group for parents (i.e., FBT + EC). We targeted families high in critical comments and low warmth (assessed by the Five-Minute Speech Sample), known predictors of poor response in FBT. Eligible participants included adolescents initiating outpatient FBT, diagnosed with AN/AAN, ages 12-17, with a parent high in critical comments/low in warmth. The first phase of the study was an open pilot which demonstrated feasibility and acceptability of FBT + EC. Thus, we proceeded with the small randomized controlled trial (RCT). Eligible families were randomized to either 10 weeks of FBT + EC parent group treatment or the 10- week parent support group (control condition). The primary outcomes were parent critical comments and parental warmth, while our exploratory outcome was adolescent weight restoration. Novel aspects of the trial design (e.g., specifically targeting typical treatment non-responders), as well as recruitment and retention challenges in the context of the COVID-19 pandemic are discussed.
Collapse
Affiliation(s)
- Claire M Aarnio-Peterson
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Abigail Matthews
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
- Department of Psychiatry and Neurosciences, University of Chicago, Chicago, IL, 60637, USA
| | - Anne Shaffer
- Department of Psychology, University of Georgia, Athens, GA, USA
| |
Collapse
|
6
|
Modi AC. Editorial: Stepping in and Stepping up: The Next 5 Years for the Journal of Pediatric Psychology. J Pediatr Psychol 2023; 48:1-4. [PMID: 36215669 PMCID: PMC10089572 DOI: 10.1093/jpepsy/jsac074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati-College of Medicine, USA
| |
Collapse
|
7
|
Schwartz LA, Lewis AM, Alderfer MA, Vega G, Barakat LP, King-Dowling S, Psihogios AM, Canter KS, Crosby L, Arasteh K, Enlow P, Hildenbrand AK, Kassam-Adams N, Pai A, Phan TL, Price J, Schultz CL, Sood E, Wood J, Kazak A. COVID-19 Exposure and Family Impact Scales for Adolescents and Young Adults. J Pediatr Psychol 2022; 47:631-640. [PMID: 35459946 PMCID: PMC9425841 DOI: 10.1093/jpepsy/jsac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on adolescents and young adults (AYAs), we adapted the COVID-19 Exposure and Family Impact Scales (CEFIS; Kazak et al., 2021) for AYAs. Here, we report on the development, structure, and psychometric properties of the CEFIS-AYA. METHODS The CEFIS-AYA was developed by a multidisciplinary, multi-institutional team using a rapid iterative process. Data from 3,912 AYAs from 21 programs at 16 institutions across the United States were collected from May 2020 to April 2021. We examined the underlying structure of the CEFIS-AYA using principal component analysis (PCA), calculated internal consistencies, and explored differences in scores by gender and age. RESULTS Participants reported exposure to a range of COVID-19-related events (M = 9.08 events, of 28). On the bidirectional 4-point Impact scale, mean item scores were mostly above the midpoint, indicating a slightly negative impact. Kuder-Richardson 20/Cronbach's Alpha was good for Exposure (α = .76) and excellent for Impact (α = .93). PCA identified seven factors for Exposure (Severe COVID-19, Loss of Income, Limited Access to Essentials, COVID-19 Exposure, Disruptions to Activities, Disruptions to Living Conditions, and Designation as an Essential Worker) and five for Impact (Self and Family Relationships, Physical Well-Being, Emotional Well-Being, Social Well-Being, and Distress). Gender and age differences in CEFIS-AYA scores were identified. DISCUSSION Initial reliability data are strong and support use of the CEFIS-AYA for measuring the effect of the COVID-19 pandemic on AYAs in research and clinical care.
Collapse
Affiliation(s)
- Lisa A Schwartz
- Children’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Melissa A Alderfer
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | | | - Lamia P Barakat
- Children ’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Alexandra M Psihogios
- Children’s Hospital of Philadelphia , USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Kimberly S Canter
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Lori Crosby
- Cincinnati Children’s Hospital Medical Center, USA
| | | | - Paul Enlow
- Nemours Children’s Heal th, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Aimee K Hildenbrand
- Nemour s Children’s Health, USA
- Sidney Kimmel Medical College , Thomas Jefferson University, USA
| | - Nancy Kassam-Adams
- Children’s Hospital of Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Ahna Pai
- Cincinnati Children’s Hospital Medical Center, USA
| | - Thao-Ly Phan
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Julia Price
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Corinna L Schultz
- Nemours Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Erica Sood
- Nemour s Children’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | | | - Anne Kazak
- Nemours Ch ildren’s Health, USA
- Sidney Kimmel Medical College, Thomas Jefferson University , USA
| |
Collapse
|
8
|
Amico KR, Lindsey JC, Hudgens M, Dallas R, Horvath KJ, Dunlap A, Goolsby R, Johnson MM, Heckman B, Crawford J, Secord E, Purswani M, Reirden D, Rathore M, Robinson LG, Gaur AH. Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV. AIDS Behav 2022; 26:3897-3913. [PMID: 35670987 PMCID: PMC9171094 DOI: 10.1007/s10461-022-03717-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Youth living with HIV (YLWH) in the US have low rates of viral suppression (VS). In a prospective randomized clinical trial (ATN152) that enrolled 89 YLWH on antiretroviral therapy (ART) with detectable viral load, we evaluated a 12 week triggered escalating real-time adherence (TERA) intervention with remote coaching, electronic dose monitoring (EDM), and outreach for missed/delayed doses compared to standard of care (SOC). Median [Q1, Q3] percent days with EDM opening was higher in TERA (72% (47%, 89%)) versus SOC (41% (21%, 59%); p < 0.001) and incidence of numbers of 7 day gaps between openings were lower (TERA to SOC ratio: 0.40; 95% CI 0.30, 0.53; p < 0.001). There were no differences in VS at week 12 (TERA 35%; 95% CI 21%, 51% versus SOC 36%; 95% CI 22%, 51%; p > 0.99) or later time-points. The intervention improved adherence but not VS in heavily ART-experienced YLWH. Remote coaching more closely tailored to the unique dosing patterns and duration of need for youth struggling to reach VS warrants further investigation.
Collapse
Affiliation(s)
- K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Jane C Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael Hudgens
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Keith J Horvath
- Department of Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Amanda Dunlap
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Rachel Goolsby
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Mueller Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY, USA
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | | | | | - Danial Reirden
- Children's Hospital Colorado, University of Colorado Denver, Denver, CO, USA
| | - Mobeen Rathore
- Education and Service (UF CARES), University of Florida Center for HIV/AIDS Research, Jacksonville, FL, USA
| | | | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | |
Collapse
|
9
|
Krämer LV, Mueller-Weinitschke C, Zeiss T, Baumeister H, Ebert DD, Bengel J. Effectiveness of a web-based behavioural activation intervention for individuals with depression based on the Health Action Process Approach: protocol for a randomised controlled trial with a 6-month follow-up. BMJ Open 2022; 12:e054775. [PMID: 35074820 PMCID: PMC8788228 DOI: 10.1136/bmjopen-2021-054775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Behavioural activation is a highly effective treatment for depression. However, there is considerable heterogeneity of interventions grouped under the term 'behavioural activation'. A main reason for the heterogeneity is the lack of a unified theory in the intervention development: few of the established intervention manuals give a theoretical rationale for their intervention techniques. For the first time, this study will examine the effectiveness of a theory-based behavioural activation intervention (InterAKTIV) based on the Health Action Process Approach. The intervention is implemented online to ensure broad dissemination and standardisation. METHODS AND ANALYSIS In a two-arm randomised controlled trial, the effectiveness of a guided web-based behavioural activation intervention for people with depression will be evaluated. Participants are recruited via the print and online media of a large German healthcare insurance company. Individuals (age 18-65), who meet criteria for major depressive episode in a clinical interview and no exclusion criteria are eligible for inclusion. A target sample of 128 participants is randomly allocated to either the intervention group (immediate access to InterAKTIV) or treatment as usual (access after follow-up assessment). The primary outcome of depressive symptom severity (Quick Inventory of Depressive Symptomatology Clinician Rating) and secondary outcomes, including behavioural activation, physical activity and motivational and volitional outcomes are assessed at baseline, post treatment and 6-month follow-up. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. ETHICS AND DISSEMINATION This trial is approved by the ethics committee of the Albert-Ludwigs-University of Freiburg (no.: 20-1045). All participants are required to submit their informed consent online before study inclusion. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER This trial was registered in the German Clinical Trials Register (DRKS): DRKS00024349 (date of registration: 29 January 2021).
Collapse
Affiliation(s)
- Lena Violetta Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claudia Mueller-Weinitschke
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tina Zeiss
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
10
|
Steinberg RI, Begay JA, Begay PM, Goldtooth DL, Nelson ST, Yazzie DA, Delamater AM, Hockett CW, Phimphasone-Brady P, Powell JC, Sinha M, Dabelea D, Sauder KA. Lessons on Resilient Research: Adapting the Tribal Turning Point Study to COVID-19. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:155-182. [PMID: 35881986 PMCID: PMC9837807 DOI: 10.5820/aian.2902.2022.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Tribal Turning Point (TTP) is a community-based randomized controlled trial of a lifestyle intervention to reduce risk factors for type 2 diabetes in Native youth. TTP began in 2018 and was interrupted by the COVID-19 pandemic in 2020. In this paper we aimed to understand 1) how the pandemic impacted TTP's operations, and how the TTP team successfully adapted to these impacts; 2) how the effects of COVID-19 and our adaptations to them were similar or different across TTP's research sites; and 3) lessons learned from this experience that may help other Native health research teams be resilient in this and future crises. Using a collaborative mixed methods approach, this report explored five a priori domains of adaptation: intervention delivery, participant engagement, data collection, analytic strategies, and team operations. We derived three lessons learned: 1) ensure that support offered is flexible to differing needs and responsive to changes over time; 2) adapt collaboratively and iteratively while remaining rooted in community; and 3) recognize that relationships are the foundation of successful research.
Collapse
Affiliation(s)
- Rachel I. Steinberg
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Joel A. Begay
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Paula M. Begay
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Deidra L. Goldtooth
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Shawna T.M. Nelson
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Debra A. Yazzie
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | | | | | | | | | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the University of Arizona College of Medicine
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| |
Collapse
|
11
|
Kazak AE, Alderfer M, Enlow PT, Lewis AM, Vega G, Barakat L, Kassam-Adams N, Pai A, Canter KS, Hildenbrand AK, McDonnell GA, Price J, Schultz C, Sood E, Phan TL. COVID-19 Exposure and Family Impact Scales: Factor Structure and Initial Psychometrics. J Pediatr Psychol 2021; 46:504-513. [PMID: 33749794 PMCID: PMC8083683 DOI: 10.1093/jpepsy/jsab026] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022] Open
Abstract
Objective In response to the rapidly unfolding coronavirus disease 2019 (COVID-19) pandemic in spring 2020, we developed a caregiver-report measure to understand the extent to which children and families were exposed to events related to COVID-19 and their perceptions of its impact. This article reports on the factor structure and psychometric properties of this measure. Methods The COVID-19 Exposure and Family Impact Scales (CEFIS) were developed by a multidisciplinary, multi-institutional team using a rapid iterative process. Data from 1805 caregivers recruited from 28 programs at 15 institutions across the United States were collected from May—September 2020. We examined the underlying structure of the CEFIS using exploratory factor analyses and its internal consistency (Cronbach’s alpha). Results Participants reported a range of COVID-19-related events (M = 8.71 events of 25). On the bidirectional 4-point impact scale, mean scores were mostly above the midpoint, indicating a slightly negative impact. Cronbach’s alpha was excellent for Exposure (α = .80) and Impact (α = .92). Factor analysis identified six factors for Exposure (COVID-19 experiences, Access to essentials, Disruptions to living conditions, Loss of income, Family caregiving and activities, and Designation as an essential worker). There were three factors for Impact (Personal well-being, Family interactions, and Distress). Discussion The CEFIS has strong factors assessing Exposure to events related to COVID-19, and the Impact of these events on families of children in pediatric healthcare. These initial validation data support use of the CEFIS for measuring the effect of the pandemic.
Collapse
Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Melissa Alderfer
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Paul T Enlow
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | | | | | - Lamia Barakat
- Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Nancy Kassam-Adams
- Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Ahna Pai
- Cincinnati Children's Hospital Medical Center
| | - Kimberly S Canter
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Aimee K Hildenbrand
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | | | - Julia Price
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Corinna Schultz
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Erica Sood
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| | - Thao-Ly Phan
- Nemours Children's Health System.,Sidney Kimmel Medical College of Thomas Jefferson University
| |
Collapse
|